Early Gastric Cancer: The First Case Series in Thailand
Asada Methasate MD, PhD*, Atthaphorn Trakarnsanga MD*, Thawatchai Akaraviputh MD*, Vitoon Chinsawangwathanakol MD, PhD*, Darin Lohsiriwat MD*
Affiliation : * Minimally Invasive Surgery Center, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Early gastric cancer (EGC) defined as gastric cancer involving up to submucosal layer, regardless of lymph
node metastasis, is increasingly found at Siriraj Hospital. Understanding the characteristic of EGC and result of surgical
management for EGC can help to choose the optimal treatment. In the present study, the authors reported the first case series
in Thailand.
Material and Method: The authors analyzed 21 consecutive EGC patients treated with gastrectomy with lymph node
dissection between September 2001 and December 2009 at Minimally Invasive Surgery Center, Division of General Surgery,
Department of Surgery, Siriraj Hospital, Mahidol University, Thailand.
Results : Ratio of EGC to total cases of gastric cancer was increasing yearly, from 1.8% in 2006 to 8.1% in 2009 at Siriraj
Hospital. The most common type of EGC was type IIc (66.7%) while type III was found in 19%, and type I in 14.3%. The
tumor invaded mucosal layer in 42.9% and submucosal layer in 57.1% of the patients. For N staging, 76.2% of the patients
were N0 while N1 was 19% and N2 was 4.8%. Overall, lymph node metastasis was found in 23.8%. For mucosal cancer (m),
no lymph node metastasis was seen while for submucosal cancer (sm) five cases (41.7%) had lymph node metastasis,
especially in one patient that the metastasis was in N2 group. Lymphatic invasion was seen in 14.3% of cases. All cases with
lymphatic invasion were all submucosal cancer. Overall staging was stage 1a in 76.2%, stage 1b in 19%, and stage 2 in
4.8%. Morbidity was seen in 14.3% of the cases. No mortality was seen. The survival was excellent with no recurrence found
during the follow-up period of the present study (mean 30.53 months).
Conclusion : Surgery for EGC has good results with minimal complications and excellent 5-year survival. Less invasive
treatment has become the option for EGC. Understanding the characteristic of EGC and careful selection to assign appropriate
treatment is important to improve the result in the treatment of EGC.
Keywords : Early gastric cancer, Gastric cancer, Gastrectomy
